IN THE NAME OF GOD Dr. Kheirandish Oral and maxillofacial pathology

Transcription

1 IN THE NAME OF GOD Dr. Kheirandish Oral and maxillofacial pathology

2 ORAL FOCAL MUCINOSIS Uncommon Tumorlike Cutaneous myxoid cyst Overproduction of hyaluronic acid by firoblasts Young adults Female Gingiva > hard palate Sessile or pedunculated Painless Smooth

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4 Histopathologic Features o Well-localized but nonencapsulated o Loose, myxomatous connective tissue o Rete ridges o Firoblasts (within the mucinous area) ovoid, stellate o Few capillaries o Mucinous product is hyaluronic acid

5 GRANULAR CELL TUMOR Uncommon neoplasm Oral cavity Schwann cells Solitary Multiple (black patients)

6 Fourth to sixth decades Female Asymptomatic Sessile nodule Pink \ yellow Tongue > buccal mucosa

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8 Histopathologic Features o Large, polygonal cells o (pale eosinophilic, granular cytoplasm \ dark or vesicular nuclei) o Sheets \ cords \ nests o Not encapsulated o Overlying epithelium o S-100 protein

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10 CONGENITAL EPULIS (CONGENITAL EPULIS OF THE NEWBORN; CONGENITAL GRANULAR CELL LESION) Uncommon Alveolar ridges of newborns Slight microscopic resemblance to the granular cell tumor Pink-to-red Smooth-surfaced Polypoid mass Maxillary ridge Females 90%

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12 Histopathologic Features o Large, rounded cells o (Abundant granular, eosinophilic cytoplasm and round o To oval, lightly basophilic nuclei) o Overlying epithelium o S-100 protein

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14 MALIGNANT MESENCHYMAL TUMOR

15 Sarcoma Carcinoma Oral cavity : Rare o Fibrosarcoma o Malignant Fibrous Histiocytoma o Liposarcoma o Malignant schwannoma o Olfactory Neuroblastoma o Angiosarcoma o Kaposi's Sarcoma o Leiomyosarcoma o Rhabdomyosarcoma o Metastases to the Oral Soft Tissues

16 Fibrosarcoma Malignant tumor of fibroblasts Extremities Head and neck :10% Slow-growing Anywhere in the head and neck young adults and children

17 HISTOPATHOLOGIC FEATURES Well-differentiated : Fascicles Spindle-shaped cells Herringbone pattern Mitotic figures Poorly-differentiated : Less organized Rounder or ovoid More frequent mitotic activity Poorly differentiated tumors tend to produce less collagen than do well-differentiated tumors.

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20 TREATMENT AND PROGNOSIS Surgical excision Wide margin of adjacent normal tissue Recurrence 50% 5-year survival : 40% to 70%.

21 MALIGNANT FIBROUS HISTIOCYTOMA Both fibroblastic and histiocytic features Adult Expanding mass May be painful or ulcerated HISTOPATHOLOGIC FEATURES Most common type : storiform-pleomorphic(short fascicles of plump spindle cells arranged in a storiform pattern, admixed with areas of pleomorphic giant cells) Myxoid/ giant cell/ inflammatory/ angiomatoid

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23 TREATMENT AND PROGNOSIS Aggressive Radical surgical resection Recurrences : 40% Metastases : 40% Oral tumors : worse than other body sites

24 LIPOSARCOMA Malignant neoplasm of fatty origin Most common soft tissue sarcoma in adults Head and neck : rare Most common site of the head and neck : Neck Tongue and cheek Soft Slow-growing Ill -defined Normal in color or yellow Pain or tenderness : uncommon

25 HISTOPATHOLOGIC FEATURES 1. Well-differentiated liposarcoma/atypical lipomatous tumor Most common in the oral cavity Resemble benign lipomas Scattered lipoblasts and atypicalcells 2. Myxoid/round cell liposarcoma Myxoid stroma Rich capillary network The round cell liposarcoma is a more aggressive form of myxoid liposarcoma 3. Pleomorphic liposarcoma Extreme cellular pleomorphism Bizarre giant cells 4. Dedifferentiated liposarcomas Well -differentiated liposarcoma + poorly differentiated, nonlipogenic sarcomatous

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27 TREATMENT AND PROGNOSIS Radical excision Recurrences : 15% to 20% Histopathologic subtype is important in prognosis : Pleomorphic liposarcomas is much worse than other types Oral liposarcoma : favorable (well-differentiated and small) metastasis: rare

28 MALIGNANT SCHWANNOMA Young adults Neurofiromatosis type I (29 to 36 years) Head&neck (14% to 19%) Mandible, lips, and buccal mucosa Pain

29 Histopathologic Features o Fascicles of atypical spindle-shaped cells o Firosarcoma o Wavy or comma-shaped nuclei o S-100 protein

30 Treatment and Prognosis Radical surgical excision Adjuvant radiation therapy and chemotherapy Prognosis poor Survival (39% to 60% at 5 years, and 26% to 45% at10 years)

31 OLFACTORY NEUROBLASTOMA (ESTHESIONEUROBLASTOMA) Arise from the olfactory epithelium Adult Nasal cavity Nasal obstruction Anosmia Epistaxis Pain

32 HISTOPATHOLOGIC FEATURES Small, round to ovoid basophilic cells Sheets and lobules Rosette and pseudorosette

33 TREATMENT AND PROGNOSIS Surgical excision Radiation therapy Chemotherapy Prognosis : Stage A (nasal cavity) / 72%-90% Stage B (paranasal Sinuses) / 59% -70% Stage C (beyond the nasal cavity and sinuses) / 50% Death : local recurrence Metastasis

34 Angiosarcoma Rare Vascular endothelium <50%...Head and neck Scalp and forehead Tongue and mandible Older adult Early lesions...simple bruise Enlarge \ elevated \ nodular \ ulcerated

35 Histopathologic Features o Infitrative proliferation of endothelium-lined blood vessels o endothelial cells hyperchromatic and atypical o Mitotic activity o CD31 \ factor VIII

36 Treatment and Prognosis Radical surgical excision Radiation therapy Prognosis poor 10-year survival (14% to 21%)

37 KAPOSI'S SARCOMA Unusual vascular neoplasm HIV HHV-8 Endothelial cells Four clinical presentations : 1. Classic 2. Endemic (African) 3. Iatrogenic immunosuppression associated 4. AIDS related

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39 CLINICAL FEATURES CLASSIC TYPE : Chronic Late adult Men Italian. Jewish, or Slavic Multiple blue-purple macules and plaques Skin of the lower extremities Grow slowly Many years Painless(tumor nodules) Oral : rare ( palate)

40 ENDEMIC TYPE : Africa 1. Benign nodular : Similar to classic 2. Aggressive or infiltrative : Locally invasive Soft tissues and bone 3. Florid : Rapidly progressive Widely disseminated Aggressive Visceral involvement 4. Iymphadenopathic : Young black children Generalized Rapidly growing Lymph nodes Visceral Skin

41 IATROGENIC TYPE : Iatrogenic Immunosuppression Organ transplants Loss of cellular immunity Immunosuppressive drugs

42 HISTOPATHOLOGIC FEATURES Three stages: 1. Patch (macular) Endothelial cells Scattered lymphocytes and plasma cells 2. Plaque Proliferation vascular channels Spindle cell 3. Nodular Spindle cells Extravasated erythrocytes Slitlike vascular

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44 TREATMENT AND PROGNOSIS Clinical subtype and stage Classic: radiation therapy Surgical excision Chemotherapy Classic / Lymphadenopathic

45 LEIOMYOSARCOMA Malignant neoplasm of smooth muscle differentiation Most common sites : uterine wall \ gastrointestinal tract Oral cavity : rare Middle-aged and older adults Enlarging mass Secondary ulceration

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48 HISTOPATHOLOGIC FEATURES Fascicles Spindle-shaped cells Blunt-ended, cigar-shaped nuclei Five or more mitoses (per 10 HPF): malignant Masson trichrome stain Myogenic markers

49 TREATMENT AND PROGNOSIS Radical surgical excision The prognosis for oral tumors is guarded

50 RHABDOMYOSARCOMA Malignant neoplasm of skeletal muscle differentiation Young children (first decade) Most common sarcomas in childhood Most frequent site: head and neck (orbit / palate) Second most common location: genitourinary tract Males

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52 Embryonal ( Botryoid / Spindle / NOS ) Most common in the first 10 years of life (60% of all cases) Alveolar ( Classic and Solid ) Between 10 and 25 years Pleomorphic Less than 5% of all cases Older than 40 years Extremities Most head and neck lesions: embryonal or alveolar types Painless Infiltrative

53 HISTOPATHOLOGIC FEATURES EMBRYONAL TYPE Small round or oval cells with hyperchromatic nuclei and indistinct cytoplasm Botryoid (grape like) : arise within a cavity demonstrate an exophytic. polypoid growth pattern that resembles a cluster of grapes. ALVEOLAR TYPE Classic pattern : poorly differentiated round to oval cells separated by fibrous septa. Solid pattern: small round basophilic cells without fibrovascular septa.

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56 TREATMENT AND PROGNOSIS Local surgical excision Chemotherapy Radiation therapy Good prognosis : EMBRYONAL type

57 METASTASES TO THE ORAL SOFT TISSUES Uncommon Lymphatic Blood-borne Most common site : gingiva Next most common site : tongue Pyogenic granuloma Adjacent teeth : loosened (underlying destruction of the alveolar bone)

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59 Male Middle-aged and older adults Men : lung cancer, renal carcinoma and melanoma Women : breast cancer, malignancies of the genital organs, lung, bone, and kidney Resemble the tumor of origin Most cases : carcinomas Metastatic sarcomas to the oral region are rare

60 TREATMENT AND PROGNOSIS Prognosis poor

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